US10946001B2 - Treatment of autoimmune diseases with combinations of RXR agonists and thyroid hormones - Google Patents

Treatment of autoimmune diseases with combinations of RXR agonists and thyroid hormones Download PDF

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US10946001B2
US10946001B2 US16/083,799 US201616083799A US10946001B2 US 10946001 B2 US10946001 B2 US 10946001B2 US 201616083799 A US201616083799 A US 201616083799A US 10946001 B2 US10946001 B2 US 10946001B2
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irx4204
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Roshantha A. Chandraratna
Martin E. Sanders
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IO Therapeutics Inc
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Definitions

  • the present disclosure is directed to methods of treating autoimmune diseases using Retinoid X Receptor (RXR) agonists in combination with thyroid hormones.
  • RXR Retinoid X Receptor
  • RXR Retinoid X Receptors
  • autoimmune disorders Attempts to treat autoimmune disorders have met with limited success. This is due, in part, to the fact that the etiology of autoimmune disorders is a complex response based in part on a combination of factors, including, without limitation, genetic make-up of individual, gender or hormonal status, bacterial or viral infection, metal or chemical toxin exposure, vaccinations or immunizations, stress, trauma, smoking and/or nutritional deficiencies. Therefore, compounds, compositions, and methods that can reduce a symptom associated with an autoimmune disorder, inflammation associated with an autoimmune disorder, and/or a transplant rejection would be highly desirable.
  • RARs Retinoic Acid Receptors
  • RXRs receptors that mediate the effects of derivatives of vitamin A in mammals (and other organisms)
  • RAR alpha, RAR beta, and RAR gamma subtypes designated RAR alpha, RAR beta, and RAR gamma for the RAR family and RXR alpha, RXR beta, and RXR gamma for the RXR family.
  • RAR alpha, RAR beta, and RAR gamma for the RAR family
  • RXR alpha, RXR beta, and RXR gamma for the RXR family.
  • retinoids ligands that activate the RXRs
  • rexinoids elicit quite different biological effects.
  • Retinoic acid the physiological hormone for all three RARs, has been shown to enhance the in vitro differentiation of Treg cells that suppress immunity.
  • RA can also inhibit the differentiation of pro-inflammatory Th17 cells that have been causally implicated in the development of many human autoimmune diseases.
  • RAR agonists Based on this ability to restore a normal Th17/Treg cell ratio by decreasing Th17 cells while simultaneously increasing Treg cells, RAR agonists have been proposed as effective therapeutic compounds for the treatment of inflammatory and autoimmune disorders.
  • recent findings have identified retinoid signaling through RARs as being required for the initial development of Th17 cell mediated immune responses and inflammation. These counteracting effects of RAR pan agonists on Th17 cell development bring into question the value of such compounds as anti-inflammatory and immunosuppressive agents.
  • RAR agonists like RA have been used to treat autoimmune disorders associated with inflammation, their usefulness in clinical practice has been limited due to unwanted side effects and counter-therapeutic inflammatory effects.
  • compounds and compositions that maintain the ability to inhibit Th17 cell formation and function and to promote Treg cell formation, but not possess any pro-inflammatory activities and other unwanted side effects associated with RAR pan agonists like RA.
  • Such compounds will be of considerable therapeutic value as immunomodulatory agents.
  • RAR Retinoic Acid Receptors
  • RXR non-selective Retinoic X Receptor
  • a method of treating an autoimmune disease comprising administering to an individual in need thereof a therapeutically effective amount of a RXR agonist and a thyroid hormone, wherein administration of the RXR agonist and thyroid hormone treats the autoimmune disease in the individual more effectively than treatment with either the RXR agonist or thyroid hormone alone.
  • the RXR agonist is a selective RXR agonist having the structure of Formula II
  • R is H or lower alkyl of 1 to 6 carbons.
  • the RXR agonist is a selective RXR agonist comprising 3,7-dimethyl-6(S),7(S)-methano,7-[1,1,4,4-tetramethyl-1,2,3,4-tetrahydronaphth-7-yl]2(E),4(E) heptadienoic acid.
  • the RXR agonist is 3,7-dimethyl-6(S),7(S)-methano,7-[1,1,4,4-tetramethyl-1,2,3,4-tetrahydronaphth-7-yl]2(E),4(E) heptadienoic acid ethyl ester.
  • the RXR agonist is bexarotene.
  • the RXR agonist is LG268.
  • the thyroid hormone is thyroxine.
  • the therapeutically effective amount of the RXR agonist is about 0.001 mg/day to about 1000 mg/day. In other embodiments, the therapeutically effective amount of the ester of a RXR agonist is about 0.001 mg/day to about 1000 mg/day. In yet other embodiments, the therapeutically effective amount of the RXR agonist is about 10 mg/day to about 1000 mg/day, about 1.0 mg/day to about 100 mg/day, or about 1 mg/day to about 20 mg ⁇ day. In some embodiments, the dose of thyroxine is about 12.5 ⁇ g/day to about 250 ⁇ g/day.
  • the RXR agonist is administered by nasal administration. In other embodiments, the RXR agonist and thyroxine are both administered by nasal administration. In other embodiments, the RXR agonist is administered orally. In yet other embodiments, the thyroxine is administered orally. In some embodiments, the thyroxine is administered subcutaneously.
  • the RXR agonist and the thyroxine are both administered substantially simultaneously. In other embodiments, the RXR agonist and thyroxine are administered on different schedules.
  • the method treats an autoimmune disease selected from the group consisting of acute disseminated encephalomyelitis (ADEM), Addison's disease, an allergy, allergic rhinitis, anti-phospholipid antibody syndrome (APS), an arthritis, asthma, acquired immunodeficiency syndrome (AIDS), autoimmune hemolytic anemia, autoimmune hepatitis, autoimmune inner ear disease, bullous pemphigoid, celiac disease, Chagas disease, chronic obstructive pulmonary disease (COPD), diabetes mellitus type 1 (IDDM), endometriosis, a gastrointestinal disorder, a glomerulonephritis, Goodpasture's syndrome, Graves' disease, Guillain-Barre syndrome (GBS), Hashimoto's thyroiditis, hidradenitis suppurativa, idiopathic thrombocytopenic purpura, interstitial nephritis, interstitial cystitis, a lupus, morph
  • the disease is not multiple sclerosis.
  • the arthritis is monoarthritis, oligoarthritis, polyarthritis, osteoarthritis, rheumatoid arthritis, juvenile idiopathic arthritis, septic arthritis, spondyloarthropathy, gout, pseudogout, or Still's disease.
  • the gastrointestinal disorder is an irritable bowel disease or an inflammatory bowel disease.
  • the inflammatory bowel disease is Crohn's disease or ulcerative colitis.
  • the lupus is discoid lupus erythematosus, drug-induced lupus erythematosus, lupus nephritis, neonatal lupus, subacute cutaneous lupus erythematosus, or systemic lupus erythematosus.
  • the myopathy is dermatomyositis, inclusion body myositis, or polymyositis.
  • the skin disorder is dermatitis, eczema, statis dermatitis, hidradenitis suppurativa, psoriasis, rosacea, or scleroderma.
  • the vasculitis is Buerger's disease, cerebral vasculitis, Churg-Strauss arteritis, cryoglobulinemia, essential cryoglobulinemic vasculitis, giant cell arteritis, Golfer's vasculitis, Henoch-Schonlein purpura, hypersensitivity vasculitis, Kawasaki disease, microscopic polyarteritis/polyangiitis, polyarteritis nodosa, polymyalgia rheumatica (PMR), rheumatoid vasculitis, Takayasu arteritis, or Wegener's granulomatosis.
  • PMR polymyalgia rheumatica
  • the autoimmune disease is multiple sclerosis, psoriasis, rheumatoid arthritis, glomerulonephritis, pulmonary fibrosis, interstitial nephritis, or an inflammatory bowel disease.
  • Also disclosed herein is a method of treating an autoimmune disease comprising of administering to an individual in need thereof a therapeutically effective amount of 3,7-dimethyl-6(S),7(S)-methano,7-[1,1,4,4-tetramethyl-1,2,3,4-tetrahydronaphth-7-yl]2(E),4(E) heptadienoic acid, and thyroxine; and wherein administration of the combination reduces the severity of the autoimmune disease in the individual and more effectively than either the RXR agonist or thyroxine alone.
  • FIG. 1 shows RXR agonist activation of transcription from RXR ⁇ , RXR ⁇ , RXR ⁇ , RAR ⁇ , RAR ⁇ , and RAR ⁇ using transactivation assays.
  • FIG. 2 shows that RXR agonists combined with thyroid hormone attenuate experimental autoimmune encephalomyelitis (EAE) in C57BL/6 mice.
  • FIGS. 3A-B shows that RXR agonists reduce leukocyte infiltration into the central nervous system.
  • FIG. 3A depicts the number of CD4 + cells and
  • FIG. 3B depicts the number of CD11c + CD11b + cells (myeloid DC) in mice treated with the selective RXR agonist IRX4204 (4204) versus the vehicle control.
  • FIG. 4 shows RXR agonists attenuate EAE in SJL mice.
  • FIGS. 5A-D shows that IRX4204 selectively activates RXR-Nurr1 heterodimers.
  • FIG. 6 shows the percentage of green fluorescent protein (EGFP) positive oligodendrocytes after culture of oligodendrocyte precursor cells derived from embryonic mouse brains with IRX4204 and thyroid hormone.
  • EGFP green fluorescent protein
  • FIG. 7 depicts effects of selective RXR agonist IRX4204 on EAE in mice
  • FIGS. 8A-B depicts expression of CCR6 ( FIG. 8A ) and CD49d ( FIG. 8B ) on splenocytes from EAE mice treated with 200 ⁇ g/day of IRX4204 or control.
  • FIGS. 9A-D depicts quantification ( FIG. 9A ) and frequency ( FIG. 9B ) of CD4+CD25hi cells, total number of effector and memory CD4 T cells ( FIG. 9C ), and total number of activated CD4 T cells ( FIG. 9D ) in splenocytes from EAE mice treated with 200 ⁇ g/day of IRX4204 or control.
  • FIG. 10 depicts the total number of infiltrating CD4 T cells in the CNS of EAE mice treated with 200 ⁇ g/day of IRX4204 or control.
  • FIGS. 11A-D depicts re-stimulation of the infiltrating lymphocytes of FIG. 10 to determine expression of interferon gamma (IFN ⁇ ) ( FIG. 11A ), IL-17A ( FIG. 11B ), tumor necrosis factor (TNF) ( FIG. 11C ), and IL-4 ( FIG. 11D ).
  • IFN ⁇ interferon gamma
  • FIG. 11A depicts re-stimulation of the infiltrating lymphocytes of FIG. 10 to determine expression of interferon gamma
  • IL-17A FIG. 11B
  • TNF tumor necrosis factor
  • FIG. 11D depicts re-stimulation of the infiltrating lymphocytes of FIG. 10 to determine expression of TNF ⁇
  • TNF tumor necrosis factor
  • FIGS. 12A-C depicts the quantification of co-expression of IFN ⁇ and IL-17A by CD4 T cells of FIG. 10 expressing IL-17A and not IFN ⁇ ( FIG. 12A ), IL-17A and IFN ⁇ ( FIG. 12B ), IFN ⁇ and not IL-17A ( FIG. 12C ).
  • FIG. 13 depicts changes in paw placement behavior in a rat 6-OHDA-induced model of Parkinson's disease upon treatment with compounds and combinations described herein (*P ⁇ 0.05 vs. vehicle using one way ANOVA followed by Dunnett test).
  • FIG. 14 depicts the percent and fold change of EGFP+ oligodendrocytes following treatment of oligodendrocytes with IRX4204, thyroid hormone, and Vitamin D (*: P ⁇ 0.05, student's t-test against DMSO control; Error bar, SD).
  • FIGS. 15A-C depicts the percent change of EGFP+ oligodendrocytes following treatment of oligodendrocytes with IRX4204 and thyroid hormone ( FIG. 15A : 10 nM IRX4204; FIG. 15B : 1 nM IRX4204; FIG. 15C : 0.1 nM IRX4204). *** P ⁇ 0.0001; ** P ⁇ 0.01.
  • FIGS. 16A-B depicts the effect of IRX4204 on remyelination in a cuprizone-induced demyelination model.
  • FIG. 16A depicts remyelination in the hippocampus and
  • FIG. 16B depicts remyelination in the cortex.
  • FIGS. 17A-B depicts quantitation of the size of myelinated axons.
  • the size of myelinated axons after 6 weeks of treatment were quantified by Image J. Histogram of axon size distribution demonstrates a shift in distribution to larger axon diameter in IRX4204-treated axons ( FIG. 17A ). Examination of the 3rd quartile date of axons about 0.7 ⁇ m demonstrates a significant increase (P ⁇ 0.0001) in the size of axons in the upper quartile ( FIG. 17B ).
  • FIG. 18 depicts terminal circulating serum T4 levels in animals that received vehicle, IRX4204, or IRX4204 and T4 (** P ⁇ 0.005 vs vehicle and na ⁇ ve control).
  • FIG. 19 depicts a quantification of SM132 positive ovoids in corpus callosum in animals that received vehicle, IRX4204, or IRX4204 and T4 for 6 weeks (* P ⁇ 0.05 vs Veh+Veh Control).
  • FIGS. 20A-C depicts a quantification of myelination of the corpus callosum following in vivo treatment with combinations described herein, and a separation of the data into potential responders and non-responders (one way ANOVA with Tukey's multiple comparisons, *P ⁇ 0.05 ** P ⁇ 0.01, **** P ⁇ 0.001).
  • FIG. 20A depicts the myelinated axons per CC unit;
  • FIG. 20B depicts the density of myelinated axons (per 10,000 ⁇ m 2 );
  • FIG. 20C depicts the density of SM132+ ovoids (per 250,000 ⁇ m 2 ).
  • FIGS. 21A-B depicts that RXR agonists increase Treg differentiation under Th17 conditions ( FIG. 21A ) and inhibit Th17 differentiation under Th17 conditions ( FIG. 21B ).
  • FIG. 22 depicts the effects of RAR signaling inhibition on RXR agonist inducement of Treg differentiation.
  • RXR Retinoid X Receptors
  • RAR means one or more of RAR ⁇ , ⁇ and ⁇ .
  • RXR generally means one or more of RXR ⁇ , ⁇ , and ⁇ .
  • a RAR biomarker is a distinctive biological, biochemical or biologically derived indicator that signifies patient RAR activity.
  • RAR biomarkers include, but are not limited to, CYP26 levels, CRBPI levels and the like and combinations thereof.
  • RAR activation threshold means one or more of (1) a CYP26 level which is 25% increased over baseline and (2) a CRBPI level 25% increased over baseline.
  • the RARs always form heterodimers with RXRs and these RAR/RXR heterodimers bind to specific response elements in the promoter regions of target genes.
  • the binding of RAR agonists to the RAR receptor of the heterodimer results in activation of transcription of target genes leading to retinoid effects.
  • RXR agonists do not activate RAR/RXR heterodimers.
  • RXR heterodimer complexes like RAR/RXR can be referred to as non-permissive RXR heterodimers as activation of transcription due to ligand-binding occurs only at the non-RXR protein (e.g., RAR); activation of transcription does not occur due to ligand binding at the RXR.
  • RXRs also interact with nuclear receptors other than RARs and RXR agonists may elicit some of its biological effects by binding to such RXR/receptor complexes.
  • permissive RXR heterodimers activation of transcription due to ligand-binding could occur at the RXR, the other receptor, or both receptors.
  • permissive RXR heterodimers include, without limitation, peroxisome proliferator activated receptor/RXR (PPAR/RXR), farnesyl X receptor/RXR (FXR/RXR), nuclear receptor related-1 protein/RXR (Nurr1/RXR) and liver X receptor/RXR (LXR/RXR).
  • RXRs may form RXR/RXR homodimers which can be activated by RXR agonists leading to rexinoid effects.
  • RXRs interact with proteins other than nuclear receptors and ligand binding to an RXR within such protein complexes can also lead to rexinoid effects. Due to these differences in mechanisms of action, RXR agonists and RAR agonists elicit distinct biological outcomes and even in the instances where they mediate similar biological effects, they do so by different mechanisms.
  • the unwanted side effects of retinoids such as pro-inflammatory responses or mucocutaneous toxicity, are mediated by activation of one or more of the RAR receptor subtypes. Stated another way, biological effects mediated via RXR pathways would not induce pro-inflammatory responses, and thus, would not result in unwanted side effects.
  • RXR agonist is synonymous with “RXR selective agonist” and refers to a compound that selectively binds to one or more RXR receptors like a RXR ⁇ , a RXR ⁇ , or a RXR ⁇ in a manner that elicits gene transcription via an RXR response element.
  • the term “selectively binds,” when made in reference to a RXR agonist, refers to the discriminatory binding of a RXR agonist to the indicated target receptor like a RXR ⁇ , a RXR ⁇ , or a RXR ⁇ such that the RXR agonist does not substantially bind with non-target receptors like a RAR ⁇ , a RAR ⁇ or a RAR ⁇ .
  • RXR agonist includes esters of RXR agonists.
  • the selective RXR agonist does not activate to any appreciable degree the permissive heterodimers PPAR/RXR, FXR/RXR, and LXR/RXR.
  • the RXR agonist activates the heterodimer Nurr1/RXR.
  • a selective RXR agonist is 3,7-dimethyl-6(S),7(S)-methano,7-[1,1,4,4-tetramethyl-1,2,3,4-tetrahydronaphth-7-yl]2(E),4(E) heptadienoic acid (IRX4204) disclosed herein, the structure of which is shown in Formula III.
  • the RXR agonists activates the permissive heterodimers PPAR/RXR, FXR/RXR, or LXR/RXR by about 1% or less, about 2% or less, about 3% or less, about 4% or less, about 5% or less, about 6% or less, about 7% or less, about 8% or less, about 9% or less, or about 10% or less relative to the ability of activating agonists to the non-RXR receptor to activate the same permissive heterodimer.
  • RXR agonists, which activates one or more of PPAR/RXR, FXR/RXR, or LXR/RXR include LGD1069 (bexarotene) and LGD268.
  • IRX4204 like some other RXR ligands, does not activate non-permissive heterodimers such as RAR/RXR. However, IRX4204 is unique in that it specifically activates the Nurr1/RXR heterodimer and does not activate other permissive RXR heterodimers such as PPAR/RXR, FXR/RXR, and LXR/RXR. Other RXR ligands generally activate these permissive RXR heterodimers. Thus, all RXR ligands cannot be classified as belonging to one class. IRX4204 belongs to a unique class of RXR ligands which specifically activate RXR homodimers and only one of the permissive RXR heterodimers, namely the Nurr1/RXR heterodimer.
  • Binding specificity is the ability of a RXR agonist, to discriminate between a RXR receptor and a receptor that does not contain its binding site, such as a RAR receptor.
  • esters of RXR agonists may be derived from a carboxylic acid of C1, or an ester may be derived from a carboxylic acid functional group on another part of the molecule, such as on a phenyl ring. While not intending to be limiting, an ester may be an alkyl ester, an aryl ester, or a heteroaryl ester.
  • alkyl has the meaning generally understood by those skilled in the art and refers to linear, branched, or cyclic alkyl moieties.
  • C 1-6 alkyl esters are particularly useful, where alkyl part of the ester has from 1 to 6 carbon atoms and includes, but is not limited to, methyl, ethyl, propyl, isopropyl, n-butyl, sec-butyl, iso-butyl, t-butyl, pentyl isomers, hexyl isomers, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, and combinations thereof having from 1-6 carbon atoms, etc.
  • RXR agonists or esters thereof, having the structure of formula I:
  • R 4 is lower alkyl of 1 to 6 carbons
  • B is —COOR 8 where R 8 is hydrogen or a lower alkyl of 1 to 6 carbons, and the configuration about the cyclopropane ring is cis, and the configuration about the double bonds in the pentadienoic acid or ester chain attached to the cyclopropane ring is trans in each of the double bonds.
  • an ester of a RXR agonist is a compound having the structure of formula II:
  • R is H or lower alkyl of 1 to 6 carbons.
  • a RXR agonist may be a selective RXR agonist comprising 3,7-dimethyl-6(S),7(S)-methano,7-[1,1,4,4-tetramethyl-1,2,3,4-tetrahydronaphth-7-yl]2(E),4(E) heptadienoic acid (IRX4204), and has the structure of formula III, and esters thereof:
  • the RXR agonist may be bexarotene (TARGRETIN®, 4-[1-(3,5,5,8,8-pentamethyl-6,7-dihydronaphthalen-2-yl)ethenyl]benzoic acid, LGD1069, Mylan Pharmaceuticals, Inc.), or esters thereof, and has the structure of formula IV:
  • the RXR agonist may be LG268 (LG100268, LGD268, 2-[1-(3,5,5,8,8-pentamethyl-5,6,7,8-tetrahydro-2-naphthyl)cyclopropyl]pyridine-5-carboxylic acid), or esters thereof and has the structure of formula V:
  • RXR agonists or esters thereof
  • thyroid hormone refers to thyroxine and triiodothyronine.
  • Thyroxine thyroid hormone T 4 , levothyroxine sodium
  • Thyroxine is a prohormone for triiodothyronine (T 3 ).
  • RXR agonists are known to suppress thyroid function. However, supplementation of RXR agonist therapy with thyroid hormones has not been utilized therapeutically to enhance the anti-autoimmune effects of the RXR agonist.
  • compositions comprising a RXR agonist, or esters or other derivatives thereof, and a thyroid hormone.
  • RXR agonists are IRX4204, bexarotene, and LG268.
  • esters of RXR agonists are IRX4204 ethyl ester (IRX4204EE), an ester of bexarotene, and an ester of LG268.
  • aspects of the methods of the present disclosure include, in part, treatment of a mammal.
  • a mammal includes a human, and a human can be a patient.
  • Other aspects of the present disclosure provide, in part, an individual.
  • An individual includes a mammal and a human, and a human can be a patient.
  • RXR agonists, or esters thereof, disclosed herein, or a composition comprising an RXR agonists or esters thereof, or a combination of RXR agonists, or esters thereof, and a thyroid hormone, such as thyroxine, is generally administered to an individual as a pharmaceutical composition.
  • compositions may be prepared by combining a therapeutically effective amount of at least one RXR agonist, as an active ingredient, with conventional acceptable pharmaceutical excipients, and by preparation of unit dosage forms suitable for therapeutic use.
  • pharmaceutical composition refers to a therapeutically effective concentration of an active compound, such as any of the compounds disclosed herein.
  • the pharmaceutical composition does not produce an adverse, allergic, or other untoward or unwanted reaction when administered to an individual.
  • a pharmaceutical composition disclosed herein is useful for medical and veterinary applications.
  • a pharmaceutical composition may be administered to an individual alone, or in combination with other supplementary active compounds, agents, drugs or hormones.
  • the pharmaceutical compositions may be manufactured using any of a variety of processes, including, without limitation, conventional mixing, dissolving, granulating, dragee-making, levigating, emulsifying, encapsulating, entrapping, and lyophilizing.
  • the pharmaceutical composition can take any of a variety of forms including, without limitation, a sterile solution, suspension, emulsion, lyophilizate, tablet, pill, pellet, capsule, powder, syrup, elixir, or any other dosage form suitable for administration.
  • a pharmaceutical composition produced using the methods disclosed herein may be a liquid formulation, semi-solid formulation, or a solid formulation.
  • a formulation disclosed herein can be produced in a manner to form one phase, such as, but not limited to an oil or a solid.
  • a formulation disclosed herein can be produced in a manner to form two phases, such as an emulsion.
  • a pharmaceutical composition disclosed herein intended for such administration may be prepared according to any method known to the art for the manufacture of pharmaceutical compositions.
  • Liquid formulations suitable for parenteral injection or for nasal sprays may comprise physiologically acceptable sterile aqueous or nonaqueous solutions, dispersions, suspensions or emulsions and sterile powders for reconstitution into sterile injectable solutions or dispersions.
  • Formulations suitable for nasal administration may comprise physiologically acceptable sterile aqueous or nonaqueous solutions, dispersions, suspensions or emulsions.
  • aqueous and nonaqueous carriers, diluents, solvents or vehicles include, but are not limited to, water, ethanol, polyols (propylene glycol, polyethyleneglycol (PEG), glycerol, and the like), suitable mixtures thereof, vegetable oils (such as olive oil or peanut oil) and injectable organic esters such as ethyl oleate.
  • PEG polyethyleneglycol
  • glycerol glycerol
  • suitable mixtures thereof such as olive oil or peanut oil
  • vegetable oils such as olive oil or peanut oil
  • injectable organic esters such as ethyl oleate.
  • Proper fluidity can be maintained, for example, by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of dispersions and by the use of surfactants.
  • Aqueous suspensions may include pharmaceutically acceptable excipients such as, but not limited to, a) suspending agents, as for example, sodium carboxymethyl cellulose, methylcellulose, hydroxypropylmethylcellulose, sodium alginate, polyvinylpyrrolidone, gum tragacanth and gum acacia; b) dispersing or wetting agents, as for naturally occurring phosphatide or lecithin, or condensation products of an alkylene oxide with fatty acids, such as, but not limited to, polyoxyethylene stearate, or condensation products of ethylene oxide with long chain aliphatic alcohols, such as, but not limited to, heptadecaethylene-oxycetanol, or condensation products of ethylene oxide with partial esters derived from fatty acids and a hexitol, such as polyoxyethylene sorbitol monoleate or condensation products of ethylene oxide with partial esters derived from fatty acids and hexitol anhydrides, such as, but not limited to, polyoxyethylene sorb
  • the aqueous suspensions can also contain one or more preservatives, ethyl- or -n-propyl-p-hydroxy benzoate, one or more coloring agents, one or more flavoring agents and one or more sweetening agents, such as, but not limited to, sucrose, saccharin or sodium or calcium cyclamate.
  • Fine particle dusts or mists which may be generated by means of various types of metered, dose pressurized aerosols, nebulizers, or insufflators.
  • Semi-solid formulations suitable for topical administration include, without limitation, ointments, creams, salves, and gels.
  • the active compound may be admixed with at least one inert customary excipient (or carrier) such as, but not limited to, a lipid and/or polyethylene glycol.
  • Solid formulations suitable for oral administration include capsules, tablets, pills, powders and granules.
  • the active compound may be admixed with at least one inert customary excipient (or carrier) such as, but not limited to, sodium citrate or dicalcium phosphate or (a) fillers or extenders, for example but not limited to, starches, lactose, sucrose, glucose, mannitol and silicic acid, (b) binders, for example but not limited to, carboxymethylcellulose, alignates, gelatin, polyvinylpyrrolidone, sucrose and acacia, (c) humectants, for example, but not limited to, glycerol, (d) disintegrating agents, for example, but not limited to, agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain complex silicates and sodium carbonate, (e) solution retarders, for example, but not limited to, paraffin, (f) ab
  • a concentration of an RXR agonist typically may be between about 50 mg/mL to about 1,000 mg/mL.
  • a therapeutically effective amount of a therapeutic compound disclosed herein may be from about 50 mg/mL to about 100 mg/mL, about 50 mg/mL to about 200 mg/mL, about 50 mg/mL to about 300 mg/mL, about 50 mg/mL to about 400 mg/mL, about 50 mg/mL to about 500 mg/mL, about 50 mg/mL to about 600 mg/mL, about 50 mg/mL to about 700 mg/mL, about 50 mg/mL to about 800 mg/mL, about 50 mg/mL to about 900 mg/mL, about 50 mg/mL to about 1,000 mg/mL, about 100 mg/mL to about 200 mg/mL, about 100 mg/mL to about 300 mg/mL, about 100 mg/mL to about 400 mg/mL, about 100 mg/mL to about 500 mg/m
  • an amount of a RXR agonist may be between about 0.01% to about 45% by weight.
  • an amount of a therapeutic compound disclosed herein may be from about 0.1% to about 45% by weight, about 0.1% to about 40% by weight, about 0.1% to about 35% by weight, about 0.1% to about 30% by weight, about 0.1% to about 25% by weight, about 0.1% to about 20% by weight, about 0.1% to about 15% by weight, about 0.1% to about 10% by weight, about 0.1% to about 5% by weight, about 1% to about 45% by weight, about 1% to about 40% by weight, about 1% to about 35% by weight, about 1% to about 30% by weight, about 1% to about 25% by weight, about 1% to about 20% by weight, about 1% to about 15% by weight, about 1% to about 10% by weight, about 1% to about 5% by weight, about 5% to about 45% by weight, about 5% to about 40% by weight, about 5% to about 35% by weight, about 5% to about 30%
  • a pharmaceutical composition disclosed herein may optionally include a pharmaceutically acceptable carrier that facilitates processing of an active compound into pharmaceutically acceptable compositions.
  • pharmaceutically acceptable refers to those compounds, materials, compositions, and/or dosage forms which are, within the scope of sound medical judgment, suitable for contact with the tissues of human beings and animals without excessive toxicity, irritation, allergic response, or other problem complications commensurate with a reasonable benefit/risk ratio.
  • the term “pharmacologically acceptable carrier” is synonymous with “pharmacological carrier” and refers to any carrier that has substantially no long term or permanent detrimental effect when administered and encompasses terms such as “pharmacologically acceptable vehicle, stabilizer, diluent, additive, auxiliary, or excipient.”
  • a carrier generally is mixed with an active compound or permitted to dilute or enclose the active compound and can be a solid, semi-solid, or liquid agent. It is understood that the active compounds can be soluble or can be delivered as a suspension in the desired carrier or diluent.
  • any of a variety of pharmaceutically acceptable carriers may be used including, without limitation, aqueous media such as water, saline, glycine, hyaluronic acid and the like; solid carriers such as starch, magnesium stearate, mannitol, sodium saccharin, talcum, cellulose, glucose, sucrose, lactose, trehalose, magnesium carbonate, and the like; solvents; dispersion media; coatings; antibacterial and antifungal agents; isotonic and absorption delaying agents; or any other inactive ingredient. Selection of a pharmacologically acceptable carrier can depend on the mode of administration.
  • any pharmacologically acceptable carrier is incompatible with the active compound, its use in pharmaceutically acceptable compositions is contemplated.
  • Non-limiting examples of specific uses of such pharmaceutical carriers can be found in Pharmaceutical Dosage Forms and Drug Delivery Systems (Howard C. Ansel et al., eds., Lippincott Williams & Wilkins Publishers, 7 th ed. 1999); Remington: The Science and Practice of Pharmacy (Alfonso R. Gennaro ed., Lippincott, Williams & Wilkins, 20 th ed. 2000); Goodman & Gilman's The Pharmacological Basis of Therapeutics (Joel G.
  • a pharmaceutical composition disclosed herein may optionally include, without limitation, other pharmaceutically acceptable components (or pharmaceutical components), including, without limitation, buffers, preservatives, tonicity adjusters, salts, antioxidants, osmolality adjusting agents, physiological substances, pharmacological substances, bulking agents, emulsifying agents, wetting agents, sweetening or flavoring agents, and the like.
  • buffers include, without limitation, acetate buffers, borate buffers, citrate buffers, phosphate buffers, neutral buffered saline, and phosphate buffered saline. It is understood that acids or bases can be used to adjust the pH of a composition as needed.
  • antioxidants include, without limitation, sodium metabisulfite, sodium thiosulfate, acetylcysteine, butylated hydroxyanisole, and butylated hydroxytoluene.
  • Useful preservatives may include, but not limited to, benzalkonium chloride, chlorobutanol, thimerosal, phenylmercuric acetate, phenylmercuric nitrate, a stabilized oxy chloro composition, sodium chlorite and chelants, DTPA or DTPA-bisamide, calcium DTPA, and CaNaDTPA-bisamide.
  • Tonicity adjustors useful in a pharmaceutical composition may include, but are not limited to, salts such as sodium chloride, potassium chloride, mannitol or glycerin and other pharmaceutically acceptable tonicity adjustor.
  • the pharmaceutical composition may be provided as a salt and can be formed with many acids, including, but not limited to, hydrochloric, sulfuric, acetic, lactic, tartaric, malic, succinic, etc. Salts tend to be more soluble in aqueous or other protonic solvents than are the corresponding free base forms. It is understood that these and other substances known in the art of pharmacology can be included in a pharmaceutical composition useful herein.
  • the compounds disclosed herein may also be incorporated into a drug delivery platform in order to achieve a controlled compound release profile over time.
  • a drug delivery platform may comprise the combination disclosed herein dispersed within a polymer matrix, typically a biodegradable, bioerodible, and/or bioresorbable polymer matrix.
  • polymer refers to synthetic homo- or copolymers, naturally occurring homo- or copolymers, as well as synthetic modifications or derivatives thereof having a linear, branched or star structure. Copolymers can be arranged in any form, such as random, block, segmented, tapered blocks, graft, or triblock.
  • Polymers are generally condensation polymers. Polymers can be further modified to enhance their mechanical or degradation properties by introducing cross-linking agents or changing the hydrophobicity of the side residues. If crosslinked, polymers are usually less than 5% crosslinked, usually less than 1% crosslinked.
  • Suitable polymers may include, but are not limited to, alginates, aliphatic polyesters, polyalkylene oxalates, polyamides, polyamidoesters, polyanhydrides, polycarbonates, polyesters, polyethylene glycol, polyhydroxyaliphatic carboxylic acids, polyorthoesters, polyoxaesters, polypeptides, polyphosphazenes, polysaccharides, and polyurethanes.
  • the polymer usually comprises at least about 10% (w/w), at least about 20% (w/w), at least about 30% (w/w), at least about 40% (w/w), at least about 50% (w/w), at least about 60% (w/w), at least about 70% (w/w), at least about 80% (w/w), or at least about 90% (w/w) of the drug delivery platform.
  • biodegradable, bioerodible, and/or bioresorbable polymers and methods useful to make a drug delivery platform are described in U.S. Pat. Nos. 4,756,911; 5,378,475; 7,048,946; and U.S. Patent Publication Nos. 2005/0181017; 2005/0244464; 2011/0008437; each of which is incorporated by reference for all it discloses regarding drug delivery.
  • a polymer composing the matrix may be a polypeptide such as, but not limited to, silk fibroin, keratin, or collagen.
  • a polymer composing the matrix may be a polysaccharide such as, but not limited to, cellulose, agarose, elastin, chitosan, chitin, or a glycosaminoglycan like chondroitin sulfate, dermatan sulfate, keratan sulfate, or hyaluronic acid.
  • a polymer composing the matrix may be a polyester such as D-lactic acid, L-lactic acid, racemic lactic acid, glycolic acid, caprolactone, and combinations thereof.
  • a suitable polymer for forming a suitable disclosed drug delivery platform depends on several factors.
  • the more relevant factors in the selection of the appropriate polymer(s) include, without limitation, compatibility of polymer with drug, desired release kinetics of drug, desired biodegradation kinetics of platform at implantation site, desired bioerodible kinetics of platform at implantation site, desired bioresorbable kinetics of platform at implantation site, in vivo mechanical performance of platform, processing temperatures, biocompatibility of platform, and patient tolerance.
  • Other relevant factors that, to some extent, dictate the in vitro and in vivo behavior of the polymer include the chemical composition, spatial distribution of the constituents, the molecular weight of the polymer and the degree of crystallinity.
  • a drug delivery platform may include both a sustained release drug delivery platform and an extended release drug delivery platform.
  • sustained release refers to the release of a compound disclosed herein over a period of about seven days or more.
  • extended release refers to the release of a compound disclosed herein over a period of time of less than about seven days.
  • a sustained release drug delivery platform may release a RXR agonist disclosed herein, or the combination an RXR agonist and a thyroid hormone, with substantially first order release kinetics over a period of about 7 days after administration, about 15 days after administration, about 30 days after administration, about 45 days after administration, about 60 days after administration, about 75 days after administration, or about 90 days after administration.
  • a sustained release drug delivery platform releases a compound disclosed herein with substantially first order release kinetics over a period of at least 7 days after administration, at least 15 days after administration, at least 30 days after administration, at least 45 days after administration, at least 60 days after administration, at least 75 days after administration, or at least 90 days after administration.
  • a drug delivery platform may release a RXR agonist disclosed herein, and a thyroid hormone, with substantially first order release kinetics over a period of about 1 day after administration, about 2 days after administration, about 3 days after administration, about 4 days after administration, about 5 days after administration, or about 6 days after administration.
  • a drug delivery platform releases a compound disclosed herein with substantially first order release kinetics over a period of at most 1 day after administration, at most 2 days after administration, at most 3 days after administration, at most 4 days after administration, at most 5 days after administration, or at most 6 days after administration.
  • aspects of the present disclosure include, in part, administering a RXR agonist, or a RXR agonist in combination with a thyroid hormone, such as thyroxine.
  • administering means any delivery mechanism that provides a compound, a composition, or a combination disclosed herein to an individual that potentially results in a clinically, therapeutically, or experimentally beneficial result.
  • Administration of a RXR agonist, in combination with a thyroid hormone, disclosed herein may include individually a variety of enteral or parenteral approaches including, without limitation, oral administration in any acceptable form, such as tablet, liquid, capsule, powder, or the like; topical administration in any acceptable form, such as drops, spray, creams, gels or ointments; buccal, nasal, and/or inhalation administration in any acceptable form; rectal administration in any acceptable form; vaginal administration in any acceptable form; intravascular administration in any acceptable form, such as intravenous bolus injection, intravenous infusion, intra-arterial bolus injection, intra-arterial infusion and catheter instillation into the vasculature; peri- and intra-tissue administration in any acceptable form, such as intraperitoneal injection, intramuscular injection, subcutaneous injection, subcutaneous infusion, intraocular injection, retinal injection, or sub-retinal injection or epidural injection; intravesicular administration in any acceptable form, such as catheter instillation; and by placement device
  • biodegradable polymers and methods of use are described in, e.g., Handbook of Biodegradable Polymers (Abraham J. Domb et al., eds., Overseas Publishers Association, 1997).
  • a compound, a composition, or a combination disclosed herein may be administered to a mammal using a variety of routes.
  • Routes of administration suitable for treating an autoimmune disease as disclosed herein include both local and systemic administration. Local administration results in significantly more delivery of a compound, a composition, or a combination to a specific location as compared to the entire body of the mammal, whereas, systemic administration results in delivery of a compound, a composition, or a combination to essentially the entire body of the individual.
  • the actual route of administration of a compound, a composition, or a combination disclosed herein used can be determined by a person of ordinary skill in the art by taking into account factors, including, without limitation, the duration of treatment desired, the degree of relief desired, the duration of relief desired, the particular compound, composition, or combination, the rate of excretion of the compound, composition, or combination used, the pharmacodynamics of the compound, composition, or combination used, the nature of the other compounds to be included in the composition or combination, the particular route of administration, the particular characteristics, history and risk factors of the individual, such as, age, weight, general health and the like, the response of the individual to the treatment, or any combination thereof.
  • An effective dosage amount of a compound, a composition, or a combination disclosed herein can thus readily be determined by the person of ordinary skill in the art considering all criteria and utilizing his best judgment on the individual's behalf.
  • a compound, a composition, or a combination disclosed herein is administered systemically to a mammal. In another embodiment, a compound, a composition, or a combination disclosed herein is administered locally to a mammal. In an aspect of this embodiment, a compound, a composition, or a combination disclosed herein is administered to the site of an autoimmune disorder in the mammal.
  • RXR agonists may be administered orally, buccally, by nasal, and/or inhalation administration, intravascularly, intravenously, by intraperitoneal injection, intramuscularly, subcutaneously, intraocularly injection, by epidural injection, or by intravesicular administration; and thyroxine may be administered orally or subcutaneously or by another route.
  • the RXR agonists, and the thyroid hormone do not need to be administered by the same route or on the same administration schedule.
  • aspects of the present specification provide, in part, administering a therapeutically effective amount of a RXR agonist in combination with a thyroid hormone.
  • therapeutically effective amount is synonymous with “therapeutically effective dose” and when used in reference to treating an autoimmune disease means a dose of a compound, a composition, or a combination necessary to achieve the desired therapeutic effect and includes a dose sufficient to reduce tumor burden or place a patient into a clinical remission.
  • the amount of active component in a compound, composition, or combination disclosed herein for treating an autoimmune disorder may be varied so that a suitable dosage is obtained.
  • the actual effect amount of compound, composition, or combination disclosed herein will further depend upon factors, including, without limitation, the frequency of administration, the half-life of the compound, composition, or combination disclosed herein. It is known by a person of ordinary skill in the art that an effective amount of a compound or a composition disclosed herein can be extrapolated from in vitro assays and in vivo administration studies using animal models prior to administration to humans. Wide variations in the necessary effective amount are to be expected in view of the differing efficiencies of the various routes of administration. For instance, oral administration generally would be expected to require higher dosage levels than administration by intravenous or intravitreal injection. Variations in these dosage levels can be adjusted using standard empirical routines of optimization, which are well-known to a person of ordinary skill in the art. The precise therapeutically effective dosage levels and patterns are preferably determined by the attending physician in consideration of the above-identified factors.
  • a therapeutically effective amount when administering a RXR agonist disclosed herein to a mammal, a therapeutically effective amount generally may be in the range of about 0.001 mg/day to about 3000 mg/day.
  • an effective amount of a compound or a composition disclosed herein may be about 0.01 mg/day to about 0.1 mg/day, about 0.03 mg/day to about 3.0 mg/day, about 0.1 mg/day to about 3.0 mg/day, about 0.3 mg/day to about 3.0 mg/day, about 1 mg/day to about 3 mg/day, about 3 mg/day to about 30 mg/day, about 10 mg/day to about 30 mg/day, about 10 mg/day to about 100 mg/day, about 30 mg/day to about 100 mg/day, about 100 mg/day to about 1000 mg/day, about 100 mg/day to about 300 mg/day, about 1000 mg/day to about 3000 mg/day, about 1 mg/day to about 100 mg/day, or about 1 mg/day to about 20 mg/day
  • a therapeutically effective amount of a compound or a composition disclosed herein may be at least 0.001 mg/kg/day, at least 0.01 mg/day, at least 0.1 mg/day, at least 1.0 mg/day, at least 3.0 mg/day, at least 10 mg/day, at least 30 mg/day, at least 100 mg/day, at least 300 mg/day, or at least 1000 mg/day.
  • a therapeutically effective amount of a compound or a composition disclosed herein may be at most 0.001 mg/day, at most 0.01 mg/day, at most 0.1 mg/day, at most 1.0 mg/day, at most 3.0 mg/day, at most 10 mg/day, at most 30 mg/day, at most 100 mg/day, at most 300 mg/day, at most 1000 mg/day, or at most 3000 mg/day.
  • Suitable thyroxine doses are generally from about 12.5 ⁇ g/day to about 250 ⁇ g/day orally initially with an increase in dose of about 12.5 to about 25 ⁇ g daily increments every 2-4 weeks as needed.
  • the suitable thyroxine dose is from about 5 ⁇ g/day to about 225 ⁇ g/day, from about 7.5 ⁇ g/day to about 200 ⁇ g/day, from about 10 ⁇ g/day to about 175 ⁇ g/day, from about 12.5 ⁇ g/day to about 150 ⁇ g/day, from about 15 ⁇ g/day to about 125 ⁇ g/day, from about 17.5 ⁇ g/day to about 100 ⁇ g/day, from about 20 ⁇ g/day to about 100 ⁇ g/day, from about 22.5 ⁇ g/day to about 100 ⁇ g/day, from about 25 ⁇ g/day to about 100 ⁇ g/day, from about 5 ⁇ g/day to about 200 ⁇ g/day, from about 5 ⁇ g/day, from
  • Increases in dose are generally made in increments of about 5 ⁇ g/day, about 7.5 ⁇ g/day, about 10 ⁇ g/day, about 12.5 ⁇ g/day, about 15 ⁇ g/day, about 20 ⁇ g/day, or about 25 ⁇ g/day.
  • the suitable thyroid hormone dose is a dose able to produce serum levels of T4 in the top 50%, the top 60%, the top 70%, the top 80%, or the top 90% of the normal range for the testing laboratory. As the normal range of T4 levels may vary by testing laboratory, the target T4 levels are based on normal ranges determined for each particular testing laboratory.
  • Dosing may be single dosage or cumulative (serial dosing), and may be readily determined by one skilled in the art.
  • treatment of an autoimmune disease may comprise a one-time administration of an effective dose of a compound, composition, or combination disclosed herein.
  • an effective dose of a compound, composition, or combination disclosed herein can be administered once to a mammal as a single injection or deposition at or near the site exhibiting a symptom of an autoimmune disease or a single oral administration of the compound, composition, or combination.
  • treatment of an autoimmune disease may comprise multiple administrations of an effective dose of a compound, composition, or combination disclosed herein carried out over a range of time periods, such as daily, once every few days, weekly, monthly or yearly.
  • a compound, a composition, or a combination disclosed herein may be administered once or twice weekly to a mammal.
  • the timing of administration can vary from mammal to mammal, depending upon such factors as the severity of a mammal's symptoms.
  • an effective dose of a compound, composition, or combination disclosed herein can be administered to a mammal once a month for an indefinite period of time, or until the mammal no longer requires therapy.
  • a person of ordinary skill in the art will recognize that the condition of the mammal can be monitored throughout the course of treatment and that the effective amount of a compound, composition, or combination disclosed herein that is administered can be adjusted accordingly.
  • the method may further include measuring the patient's C max of the RXR agonist and adjusting the dose to maintain the patient's C max at an optimal level.
  • the RXR agonist is 3,7-dimethyl-6(S),7(S)-methano,7-[1,1,4,4-tetramethyl-1,2,3,4-tetrahydron-aphth-7-yl]2(E),4(E) heptadienoic acid or esters thereof.
  • the RXR agonist is TARGRETIN® or esters thereof.
  • the RXR agonist may be may be LG268 (LG100268, LGD268, 2-[1-(3,5,5,8,8-pentamethyl-5,6,7,8-tetrahydro-2-naphthyl)cyclopropyl]pyridine-5-carboxylic acid), or esters thereof.
  • the method further includes treating the patient with one or more triglyceride lowering agents.
  • the autoimmune disorder can be a systemic autoimmune disorder or an organ-specific autoimmune disorder.
  • an autoimmune disorder that can be treated using a compound, composition, or combination disclosed herein include acute disseminated encephalomyelitis (ADEM), Addison's disease, an allergy, allergic rhinitis, anti-phospholipid antibody syndrome (APS), an arthritis such as, e.g., monoarthritis, oligoarthritis, or a polyarthritis like osteoarthritis, rheumatoid arthritis, juvenile idiopathic arthritis, septic arthritis, spondyloarthropathy, gout, pseudogout, or Still's disease, asthma, acquired immunodeficiency syndrome, acquired immunodeficiency syndrome (AIDS), autoimmune hemolytic anemia, autoimmune hepatitis, autoimmune inner ear disease, bullous pemphigoid, celiac disease, Chagas disease, chronic obstructive pulmonary disease (COPD), diabetes mellitus type 1
  • the disease is not multiple sclerosis.
  • the autoimmune disease is psoriasis, glomerulonephritis, pulmonary fibrosis, rheumatoid arthritis, or an inflammatory bowel disease.
  • aspects of the present disclosure includes, in part, reducing at least one symptom associated with an autoimmune disorder.
  • the actual symptoms associated with an autoimmune disorder disclosed herein are well known and can be determined by a person of ordinary skill in the art by taking into account factors, including, without limitation, the location of the autoimmune disorder, the cause of the autoimmune disorder, the severity of the autoimmune disorder, the tissue or organ affected by the autoimmune, and the inflammation associated with the autoimmune disorder.
  • Non-limiting examples of a symptom reduced by a method of treating an autoimmune disorder disclosed herein include inflammation, fatigue, pain, cognitive deficits, neurologic deficits, dizziness, malaise, elevated fever and high body temperature, extreme sensitivity to cold in the hands and feet, weakness, soreness, and/or stiffness in muscles and joints, weight changes, digestive or gastrointestinal problems, breathing problems, low or high blood pressure, irritability, anxiety, or depression, infertility or reduced sex drive (low libido), blood sugar changes, and depending on the type of autoimmune disease, an increase in the size of an organ or tissue, or the destruction of an organ or tissue.
  • Non-limiting examples of an inflammation symptom reduced by a method of treating an autoimmune disorder disclosed herein include pain, loss of neurologic function, loss of cognitive function, edema, hyperemia, erythema, bruising, tenderness, stiffness, swollenness, fever, a chill, congestion of the respiratory tract including nose, and bronchi, congestion of a sinus, a breathing problem, fluid retention, a blood clot, a loss of appetite, an increased heart rate, a formation of granulomas, fibrinous, pus, or non-viscous serous fluid, a formation of an ulcer, or pain.
  • treatment with a combination of an RXR agonist and a thyroid hormone reduces at least one symptom, at least two symptoms, at least three symptoms, at least four symptoms, or at least five symptoms of an autoimmune disorder.
  • the method may help to treat or alleviate conditions, symptoms, or disorders related to autoimmune diseases.
  • these conditions or symptoms may include, but are not limited to, anemia, asthenia, cachexia, Cushing's Syndrome, fatigue, gout, gum disease, hematuria, hypercalcemia, hypothyroidism, internal bleeding, hair loss, mesothelioma, nausea, night sweats, neutropenia, paraneoplastic syndromes, pleuritis, polymyalgia rheumatica, rhabdomyolysis, stress, swollen lymph nodes, thrombocytopenia, Vitamin D deficiency, or weight loss.
  • the administration of the combination of the RXR agonist with the thyroid hormone prolongs the survival of the individual being treated.
  • the mammal may experience improvements from the autoimmune disease as a result of treatment with the combination of RXR agonist and a thyroid hormone.
  • the method may treat rheumatoid arthritis.
  • Rheumatoid arthritis is a chronic inflammatory disorder which causes pain and swelling in a patient's joints, generally effecting joints in the hands, wrist, feet, elbows, knees, hips, shoulders, and ankles.
  • Rheumatoid arthritis is an autoimmune disease believed to be caused by the patient's immune system attacking the patient's joints causing inflammation and joint damage. Inflammation may cause damage to the cartilage and bone of the joint. Such damage can cause narrowing of joint spacing and leading the joints to become loose, unstable, painful, and immobile.
  • Clinical diagnosis of rheumatoid arthritis may be measured through the disease activity score (DAS).
  • DAS disease activity score
  • the DAS is a clinical index to measure rheumatoid arthritis disease activity by combining information measured from swollen joints, tender joints, the acute phase response, and general health.
  • the DAS has a continuous scale ranging from 0-10.
  • the level of disease activity may be interpreted as low (DAS ⁇ 2.4), moderate (2.4 ⁇ DAS ⁇ 3.7), or high (DAS>3.7).
  • a DAS ⁇ 1.6 corresponds to a state of remission according to the American Rheumatism Association (ARA) criteria.
  • ARA American Rheumatism Association
  • the DAS28 is a variation of DAS.
  • DAS28 consists of a 28 tender joint count, a 28 swollen joint count (range 0-28), erythrocyte sedimentation rate (ESR), and an optional general health assessment on a visual analogue scale (range 0-100).
  • the level of disease activity can be interpreted as low (DAS28 ⁇ 3.2), moderate (3.2 ⁇ DAS28 ⁇ 5.1), or high (DAS28>5.1).
  • the DAS28 has a scale ranging from 0 to 9.4. DAS and DAS28 values cannot be directly compared.
  • the treatment of rheumatoid arthritis by the method may result in the amelioration or improvement of at least one of the symptoms related to rheumatoid arthritis.
  • These symptoms may include, but are not limited to, joint pain, stiffness, tenderness, deformity, and swelling, loss of joint range, rheumatoid nodules, fatigue, and fever.
  • the method may help to reduce inflammation and damage caused to the affected joint's cartilage and bone.
  • the method may help to prevent or reduce the disease progression of rheumatoid arthritis.
  • the method may result in the mammal having a reduced DAS score as compared to prior to treatment. In other embodiments, the mammal may experience a DAS score reduced by 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 units. In some embodiments, the method may result in the mammal having a reduced DAS28 score as compared to prior to treatment. In other embodiments, the mammal may experience a DAS28 score reduced by 1, 2, 3, 4, 5, 6, 7, 8, or 9 units.
  • the method may be used to treat psoriasis and/or psoriatic arthritis.
  • Psoriasis is a chronic, autoimmune disease caused by the immune system attacking skin cells which then causes abnormally accelerated growth of skin cells. As a result, an unusually high number of old skin cells and white blood cells are pushed to the skin's surface causing itchy patches of red skin and silvery scales and systemic inflammation.
  • Psoriasis often affects the elbows, knees, scalp, lower back, face, palms, feet, fingernails, toenails, and mouth. Psoriasis episodes can be triggered by a number of factors, including infections, medications, injuries, and stress.
  • Types of psoriasis include plaque, guttate, inverse, pustular, and erythrodermic.
  • Psoriasis is typically diagnosed by a dermatologist or other medical professional who considers the patient's medical history and examines the affected skin, scalp, and/or nails. Affected skin may also be examined under a microscope; skin affected by psoriasis generally looks thicker and inflamed as compared to non-affected skin.
  • Psoriasis is also associated with psoriatic arthritis which is an inflammatory-type of arthritis. Psoriatic arthritis can generally affect any joint and can cause soreness, stiffness, swelling, and can lead to joint damage.
  • PASI Psoriasis Area and Severity Index
  • the treatment of psoriasis and/or other conditions associated with psoriasis by the method may result in the amelioration or improvement of at least one of the symptoms related to psoriasis and/or other conditions associated with psoriasis, such as psoriatic arthritis.
  • These symptoms may include, but are not limited to, itchiness, patches of skin, dry cracked skin, pain, pustules, rash, inflammation, hypothermia, dehydration, malnutrition, burning, soreness; thickened, pitted, or ridged nails; leukonychia, subungual hyperkeratosis, loosened nails, nail crumbling, splinter hemorrhage, spotted lunula, onychornycosis, paronychia, hair loss, swollen and/or stiff joints, nail discoloration, joint pain, redness, swelling, reduced range of joint motion, ulceris, uveitis, spondylitis, and skin bleeding.
  • the method may reduce the number and/or duration of psoriatic episodes experienced by the patient.
  • the method may be used to treat glomerulonephritis (nephritis).
  • Glomerulonephritis is a condition where the glomeruli of the kidney become inflamed. The glomeruli remove excess fluid, electrolytes, and waste from the bloodstream to be excreted in urine. Glomerulonephritis can be acute, such as from infection or injury, or of gradual/chronic onset. Primary glomerulonephritis occurs without cause from another condition while secondary glomerulonephritis is caused by another disease, such as lupus, diabetes, Goodpasture's syndrome, Wegener's disease, or polyarteritis nodosa .
  • Non-proliferative forms of glomerulonephritis include, but are not limited to, Minimal Change Disease (MCD, or Nil Lesions, Nil Disease, or lipoid nephrosis), focal segmental glomerulosclerosis, membranous gomerulonephritis, and thin basement disease.
  • MCD Minimal Change Disease
  • Proliferative forms of glomerulonephritis may include, but are not limited to, IgA nephropathy (Berger's disease), post-infectious glomerulonephritis, membranoproliferative glomerulonephritis, and rapidly progressive glomerulonephritis.
  • the treatment of glomerulonephritis by the method may result in the amelioration or improvement of at least one symptom associated with the glomerulonephritis or subsequent kidney dysfunction.
  • These symptoms may include, but are not limited to, edema, swelling, hematuria, proteinuria, decreased urination, increased nighttime urination, darkened urine, abdominal pain, nosebleeds, high blood pressure, foamy urine, decrease/lack of appetite, nausea, vomiting, tiredness, difficulty sleeping/insomnia, dry and itchy skin, nighttime muscle cramps, reduced kidney function, electrolyte imbalances, blood in vomit or stools, cough and shortness of breath, diarrhea, fever, joint or muscle aches, and urinary tract infections (UTIs).
  • UTIs urinary tract infections
  • treatment of glomerulonephritis may help to treat or prevent complications due to glomerulonephritis such as, but not limited to, acute kidney failure, chronic kidney failure, congestive heart failure, malignant hypertension, and susceptibility to other infections.
  • the patient may show improved kidney function. Improved kidney function may be shown through laboratory tests, such as through urinalysis testing. In other embodiments, the patient may return to what is considered medically normal urinalysis after treatment with the method.
  • the patient may have creatinine clearance levels of about 75 mL/min to about 150 mL/min for men and about 80 mL/min to about 130 mL/min for women, urine specific gravity of about 1.000 to about 1.050, urine RBC levels of about four RBCs or less per sample, urine osmolality levels of about 50 mOsm/kg and about 1250 mOsm/kg, blood iron levels of about 50 ⁇ g/dL to about 170 ⁇ g/dL in men and about 35 ⁇ g/dL to about 165 ⁇ g/dL in women, an albumin level of about 3.0 g/dL to about 5.0 g/dL, an average urea nitrogen level of about 4 mg/dL to about 6 mg/dL or about 5 mg/dL for low protein diets (e.g., about 0.5 g/kg body weight daily protein intake), about 10 mg/dL to about 15 mg/dL or about 12 mg/dL for average protein diets (
  • the method may be used to treat pulmonary fibrosis.
  • Fibrosis is a condition which general leads to excessive accumulation and deposition of extracellular matrix (ECM), immune components, connective, and/or scar tissue within the body. Fibrosis can lead to scarring, inflammation, or damage and possibly the ultimate failure of the tissue or organ where the fibrosis occurs.
  • ECM extracellular matrix
  • the scar tissue accumulates in the lung's air sac walls, thickening the air sac walls, and making it difficult for oxygen to enter the blood.
  • Pulmonary fibrosis is not known to have one specific cause (i.e., idiopathic), however, it may be a secondary condition caused by other exposure.
  • Some risk factors which have been associated with pulmonary fibrosis include cigarette smoking, viral infections, environmental pollutants (e.g., silica, hard metal dusts, bacterial/animal proteins, gas/fumes, asbestos fibers, grain dust, bird and animal droppings, etc.), certain medications, genetics, and gastroesophageal reflux disease (GERD).
  • Certain autoimmune diseases have been associated with the development of pulmonary fibrosis, including, but not limited to, Churg-Strauss syndrome, lupus, polymyositis/dermatomyositis, polyangiitis, rheumatoid arthritis, and scleroderma.
  • Pulmonary fibrosis is generally diagnosed through evaluation of patient history and physical examination, computerized tomography (CT) scan, removal of lung tissue (biopsy), and pulmonary function tests.
  • Pulmonary functions tests may include spirometry, pulse oximetry, arterial blood gas test, and exercise testing; abnormal pulmonary function may be the result of restriction vital capacity (VC) often with an increased forced expiratory volume in 1 sec (FEV 1 )/forced vital capacity (FVC) ratio and/or impaired gas exchange (increased alveolar-arterial oxygen gradient (AaPo 2 ) with rest or exercise or decreased diffusing capacity of the lung for carbon monoxide (D L CO ).
  • VC restriction vital capacity
  • FEV 1 forced expiratory volume in 1 sec
  • FVC forced vital capacity
  • AaPo 2 impaired gas exchange
  • the treatment of pulmonary fibrosis by the method may result in the amelioration or improvement of at least one symptom associated with pulmonary fibrosis.
  • These symptoms may include, but are not limited to, exertional dyspnea, non-productive/dry cough, shortness of breath, weight loss, low-grade fivers, fatigue, arthralgias, myalgias, fine bibasilar inspiratory crackles (Velcro crackles), digital clubbing, apnea, or pulmonary hypertension.
  • the treatment of pulmonary fibrosis by the method may result in the amelioration or prevention of at least one complication associated with pulmonary. These complications may include, but are not limited to, heart attack, stroke, pulmonary embolism, respiratory failure, heart failure, or lung infections.
  • the patient may show a decrease in existing fibrotic tissue or a decrease in the formation of new fibrotic tissue after treatment with the method.
  • the patient may have improved lung function after treatment with the method.
  • the patient may have a FVC and FEV 1 , which is repeatable to within 0.15 L upon repeat efforts, or if the largest value for either FVC or FEV 1 less than 1 L, then the patient may have a repeatability to within 0.1 L of the largest value.
  • the patient after treatment with the method may have a peripheral capillary oxygen saturation (SpO 2 ) of greater than about 90%, an arterial blood gas test with a partial pressure of oxygen (PaO 2 ) of about 70 mmHg to about 100 mmHg or about 10 kPa to about 13 kPa, a partial pressure of carbon dioxide (PaCO 2 ) of about 30 mmHg to about 50 mmHg, or about 4 kPa to about 6 kPa; a pH of about 7.3 to about 7.5, a bicarbonate (HCO 3 ) level of about 20 mEq/L or mmol/L to about 30 mEq/L or mmol/L, or an oxygen content (O 2 CT) level of about 20 mL/100 mL of blood to about 25 mL/100 mL of blood or about 6 mmol/L.
  • PaO 2 peripheral capillary oxygen saturation
  • the method may be used to treat an inflammatory bowel disease (IBD).
  • IBD comprises a group of conditions associated with chronic inflammation in the digestive tract. Inflammation is caused by a cell-mediated immune response in the gastrointestinal mucosa which may be caused by genetic predisposition, viral illness, or environmental factor. IBD can include such diseases as ulcerative colitis, Crohn's disease, collagenous colitis, diversion colitis, Behcet's disease, indeterminate colitis, and lymphocytic colitis.
  • the treatment of IBD by the method may result in the amelioration or improvement of at least one symptom associated with IBD.
  • symptoms may include, but are not limited to, diarrhea, rectal bleeding, abdominal pain, urgent need to move bowels, sensation of incomplete evacuation, constipation, cramping, constipation, loss of appetite, fever, weight loss, nausea, vomiting, malaise, fatigue, night sweats, loss of normal menstrual cycle, anemia, ulcers, hematochezia, arthralgias, growth delays or failed sexual maturity in children, arthritis, uveitis, liver disease, bloody stools, perianal disease, abscesses, joint pain, skin rashes, eye pain, or mouth sores.
  • the treatment of inflammatory bowel disease by the method may result in the amelioration or prevention of at least one complication associated with IBD.
  • IBD may include, but are not limited to, malnutrition, colon cancer, fistulas, strictures, fissures, intestinal rupture, or bowel obstruction.
  • IBD is generally diagnosed through patient history and elimination of other diseases through blood tests (e.g., complete blood cell tests, electrolyte panel, liver function tests, etc.), and endoscopic and imaging procedure.
  • a compound, composition, or combination disclosed herein as disclosed herein can also be administered to a mammal in combination with other therapeutic compounds to increase the overall therapeutic effect of the treatment.
  • the use of multiple compounds to treat an indication can increase the beneficial effects while reducing the presence of side effects.
  • RXR ⁇ receptor homodimers To determine whether a RXR agonist can mediate its effects via RXR ⁇ receptor homodimers, RXR ⁇ receptor homodimers, RXR ⁇ receptor homodimers, or any combination thereof, or the corresponding RAR/RXR heterodimers, receptor-mediated transactivation assays were performed.
  • transactivation assays assessing RXR homodimer signaling CV-1 cells were transfected with 1) an expression construct including a full length RXR ⁇ , RXR ⁇ , or RXR ⁇ ; and 2) a rCRBPII/RXRE-tk-Luc reporter construct that included RXR homodimer-specific RXRE/DR1 responsive element linked to a luciferase gene.
  • CV-1 cells were transfected with 1) an expression construct comprising a fusion protein including an estrogen receptor (ER) DNA binding domain linked to the ligand binding domain of RAR ⁇ , RAR ⁇ , or RAR ⁇ and 2) a ERE-tk-Luc reporter construct that included an estrogen receptor responsive element linked to a luciferase gene.
  • ER estrogen receptor
  • the ER-RAR fusion proteins provided an accurate readout of only the transfected ER-RAR.
  • CV-1 cells were treated with RXR agonist IRX4204 at increasing concentrations for 20 hours before measuring luciferase activity.
  • Luciferase activity is expressed as percent of maximal activity obtained using 1 ⁇ M RXR agonist IRX4204 for RXRs and 1 ⁇ M all-trans-retinoic acid (ATRA) for RARs (Table 1). Data are mean values ⁇ SE from five independent experiments.
  • RXR agonist IRX4204 activated RXR receptors with very high potency (EC 50 ⁇ 0.5 nM) for all three RXR subtypes (Table 1).
  • EC 50 of the RXR agonist for RARs was >1,000 nM with minimal activity detected at >1 ⁇ M. This difference represents >2,000-fold selectivity for RXRs over RARs in functional transactivation assays.
  • RXR agonist IRX4204 was more than 1,000-fold more potent in activating RXR receptors rather than RAR receptors.
  • RXR agonist IRX4204 was shown not to transactivate so called “permissive RXR heterodimers” PPAR/RXR, FXR/RXR and LXR/RXR ( FIGS. 1A-C ).
  • RXR agonist IRX4204 is distinct from other RXR agonists.
  • IRX4204 selectively activates the Nurr1/RXR permissive heterodimer ( FIG. 1D ).
  • RXR agonist IRX4204 has a unique profile in that it selectively activates only RXR homodimers and Nurr1/RXR heterodimers.
  • RXR ⁇ , RXR ⁇ , RXR ⁇ , RAR ⁇ , RAR ⁇ , or RAR ⁇ were expressed in SF21 cells using a baculovirus expression system and the resulting proteins were purified.
  • purified RXR ⁇ , RXR ⁇ , and RXR ⁇ were separately incubated with 10 nM [ 3 H]-9CRA, and the binding affinity of the RXR agonist IRX4204 was determined by competitive displacement of [ 3 H]-9CRA from the receptor.
  • RXR agonist IRX4204 displayed high affinity for RXR ⁇ , RXR ⁇ , and RXR ⁇ with K i values being 1.7, 16, and 43 nM, respectively. In contrast, the RXR agonist IRX4204 bound with very low affinity to each of the RARs (Ki values being >1,000 nM). These data indicate that IRX4204 is highly selective for the RXRs relative to the RARs.
  • C57BL/6 (B6) mice were immunized (day 0) to induce experimental autoimmune encephalomyelitis (EAE) by subcutaneous (s.c.) injection at the base of their spine with 200 ⁇ L of adjuvant containing 125 ⁇ g myelin oligodendrocyte glycoprotein peptide (35-55) (MOG peptide; Peptides International, Louisville, Ky.) and 400 ⁇ g non-viable M. tuberculosis H37 desiccate emulsified in a mixture of incomplete Freund's adjuvant and phosphate buffered saline (PBS).
  • PBS phosphate buffered saline
  • mice were also given 200 ng of pertussis toxin in PBS administered by inter-peritoneal (i.p.) injection on the same day as MOG emulsion injection (day 0) and 2 days later (day 2).
  • Statistics show the results of a Mann Whitney test (analyzed from start of treatment to the end of the experiment).
  • mice were scored using the following scale: 0—Mice have no disease, 1—Mice have distal limp tail or rear leg weakness (paresis), 1.5—Mice have distal limp tail and rear leg weakness, 2—Mice have complete limp tail and rear leg weakness, 2.5—Mice have complete limp tail and weakness in both rear legs, 3—Mice have complete limp tail and paralysis in both rear legs, 3.5—Mice have complete limp tail, paralysis in both rear legs, and forelimb weakness. Mice receiving a score of 3.5 were immediately euthanized.
  • FIG. 2 depicts scores of disease severity over time.
  • the results indicate that administration of the RXR agonist IRX4204 at 50 ⁇ g significantly reduces the symptoms of EAE in mice. Efficacy of the RXR agonist was observed after the first administration (day 7) and maintained throughout the course of the study (day 20). However, the combination of IRX4204 and thyroxine reduced the symptoms of EAE in mice to an even greater degree ( FIG. 2 ).
  • mice A dose titration experiment was also conducted in EAE mice.
  • EAE was induced in 28 B6 mice with MOG/CFA and PT as above. Mice were scored on day 7 as indicated above and divided into groups by score so means are as equal as possible. Starting day 8, mice were scored and injected with a vehicle control or IRX4204 (50 ⁇ g, 100 ⁇ g, or 200 ⁇ g) every day.
  • a vehicle control or IRX4204 50 ⁇ g, 100 ⁇ g, or 200 ⁇ g
  • mice were weighed at the beginning of experiment and every day they had a score of 2.5 or higher and mice were euthanized if they lost 15% or more of their start weight. All mice that were treated with IRX4204 had significantly less disease overall ( FIG. 7 ). At the completion of the experiment, the vehicle control and 200 ⁇ g/day groups were euthanized and spleen and CNS samples obtained.
  • the spleen samples were evaluated for CD49d ( FIG. 8A ) and CCR6 ( FIG. 8B ), and IRX4204 treatment lowered CCR6, but not CD49d, expression on CD4 T cells. Additionally, CD4+CD25hi cells (generally consisting of TReg) were reduced, although the frequency was not altered ( FIGS. 9A and 9B ).
  • CNS infiltrating cells C57BL/6 (B6) mice were treated as described in Example 6. On day 20 after immunization, mice were sacrificed and perfused with phosphate buffered saline (PBS). Brain and spinal cord tissue was isolated, digested with DNase and Liberase DL (Roche Diagnostics, Indianapolis, Ind.) for 30 minutes, and homogenized through 70 micron nylon mesh filters. Resulting cells were placed over a Percoll gradient to remove myelin. The remaining cells (microglia and CNS infiltrating cells) were counted, stained for molecules of interest, and run on a flow cytometer. Based on the frequencies obtained by FACS of these cell populations, total cell numbers of CNS infiltrating leukocytes expressing CD45, including CD4 + T cells and CD11c + CD11b + myeloid dendritic cells (DC), were calculated.
  • DC central nervous system
  • FIG. 3 compares the number of CD4 + cells or CD11c + CD11b + cells (myeloid DC) in mice treated with the RXR agonist 194204 verses the vehicle control. There was a significant reduction in the infiltration of both CD4 + cells and CD11c + CD11b + cells in animals treated with a RXR agonist as compared to the control. As disease is propagated in the CNS through the CD4 + cells infiltrating the CNS and becoming re-activated by CD11c + CD11b + cells, this suggests that part of the mechanism of action in this model is to limit the presence of the cells in the CNS.
  • mice were immunized to induce EAE by s.c. injection at the base of their spine with 200 ⁇ L of adjuvant containing 200 ⁇ g proteolipid proteins (139-151) (PLP peptide; Peptides International, Louisville, Ky.) and 400 ⁇ g of non-viable M. tuberculosis H37 desiccate emulsified in a mixture of incomplete Freund's adjuvant and PBS.
  • Mice were also given 150 ng of pertussis toxin in PBS i.p. on the same day as PLP emulsion injection and 2 days later.
  • FIG. 4 depicts scores of disease severity over time. Efficacy of the RXR agonist was observed after the second administration (day 8) and maintained throughout the course of the study (day 14). It is expected that if administration of IRX4204 was combined with thyroxine treatment, there would be a further reduction in the symptoms of EAE and disease severity scores.
  • RXR Agonist IRX4204 as a Selective Activator of Nurr1/RXR Permissive Heterodimer
  • receptor transactivation assays were carried out as follows for PPAR ⁇ /RXR, FXR/RXR, LXR ⁇ /RXR, LXR ⁇ /RXR, and Nurr1/RXR.
  • PPAR ⁇ CV-1 cells were transfected with 3 ⁇ (rAOX/DR1)-tk-Luc reporter gene and an expression vector for PPAR ⁇ .
  • FXR CV-1 cells were transfected with 3 ⁇ (IBABP/IRI)-tk-Luc reporter gene and vectors for FXR and RXR ⁇ .
  • LXR For LXR:CV-1 cells were transfected with 3 ⁇ (PLTP/LXRE)-tk-Luc reporter gene with vectors for LXR ⁇ or LXR ⁇ .
  • Nurr1 COS7 cells were transfected with 3 ⁇ NBRE-tk-luc reporter gene and full length Nurr-1 with or without full-length RXR ⁇ plasmid. Cells were then treated with vehicle or IRX4204 for 20 hr. Luciferase data were normalized to co-transfected ⁇ -gal activity. Luciferase activity was expressed as percent of maximal activity obtained using specific agonists. Rosiglitazone (PPAR ⁇ ), GW4064 (FXR), T0901317 (LXR).
  • IRX4204 does not activate FXR/RXR ( FIG. 2A ), LXR ⁇ /RXR or LXR ⁇ /RXR ( FIG. 2B ), or PPAR ⁇ /RXR ( FIG. 2C ).
  • IRX4204 potently (EC 50 ⁇ 1 nm) activates the Nurr1/RXR heterodimer ( FIG. 2D ).
  • IRX4204 is a unique RXR agonist in that it selectively activates the Nurr1/RXR heterodimer but not the PPAR ⁇ /RXR, FXR/RXR or LXR/RXR heterodimers.
  • OPCs oligodendrocyte precursor cells
  • OPCs oligodendrocyte precursor cells
  • OPCs oligodendrocyte precursor cells
  • the goal of this study was to evaluate the effect of IRX4204 on differentiation of oligodendrocyte precursor cells (OPCs) into oligodendrocytes.
  • OPCs were generated from a neurosphere culture of E14.5 PLP-EGFP (on C57BL/6J background) mouse brains.
  • the isolated OPCs were treated with IRX4204 and/or T3 to evaluate the expression of green fluorescent protein (EGFP), which correlates with differentiation of OPCs into oligodendrocytes.
  • EGFP expressing cells were quantified with Cellomics Neuronal Profiling Algorithm.
  • T3 control demonstrated differentiation of OPCs as expected.
  • IRX4204 promotes OPC differentiation into oligodendrocytes as shown by the increase in the number of the EGFP positive cells compared to negative control (DMSO). All tested concentrations showed a significant increase in OPC differentiation into oligodendrocytes ( FIG. 6 ). However, addition of T3 to the IRX4204-treated cultures induced even higher levels of EGFP+ oligodendrocytes demonstrating the significant benefit of the combination of IRX4204 and thyroid hormone.
  • IRX4204 promotes OPC differentiation into oligodendrocytes as demonstrated by the dose dependent increase in the number of the EGFP positive cells compared to negative control (DMSO). IRX4204 did not show any differences in total cell number and pyknotic cells compared to controls. The results from this study demonstrate that IRX4204 promotes OPC differentiation. The data show a dose-dependent increase in the percentage of EGFP cells compared to the negative control. These date indicate that IRX4204 promotes the growth of myelin-forming cells in cell culture.
  • IRX4204 Enhances Central Nervous System (CNS) Remyelination in an In Vivo Model by Acting Directly on the Remyelination Process
  • a focal toxin (ethidium bromide) induced rat model of demyelination is used to ascertain the direct effects of IRX4204 on acute demyelination independent of the immunomudulatory effects of IRX4204.
  • the experiment uses rats of relatively advanced age (1 year) since such rats undergo remyelination in a less efficient manner, thereby providing data that are more relevant to the clinical treatment of human patients with multiple sclerosis or other demyelination disorders.
  • Focal demyelination is induced in one year old rats (approximately 300 g in weight) by injecting stereotactically 5 ⁇ l of ethidium bromide solution (0.01% vol/vol in saline) in a bilateral manner into the caudal cerebellar peduncles (CCP).
  • CCP caudal cerebellar peduncles
  • the rats are treated by oral gavage for fourteen days (day 7 to day 21 post-ethidium bromide treatment) with 10 mg/kg/day of IRX4204 (in DMSO and corn oil), or the same dose of oral IRX4204 plus 20 ng/g of subcutaneous thyroxine, or vehicles (DMSO and corn oil plus thyroxine vehicle) for fourteen days.
  • the rats are killed on day 24 post-ethidium bromide treatment for analysis of remyelination by quantitative polymerase chain reaction (qPCR) and microscopy.
  • qPCR quantitative polymerase chain reaction
  • the cuprizone (bis-cyclohexanone oxaldihydrazone) model facilitates reliable, reproducible and unequivocal analysis of myelin parameters in both white and grey matter.
  • the cuprizone model is a model for toxic demyelination. In this model, young mice are fed with the copper chelator cuprizone, leading to oligodendrocyte death and a subsequent reversible demyelination. Cuprizone-fed mice with rapamycin, a drug that blocks mTOR and spontaneous remyelination, allows for better quantification of oligodendrocyte turnover.
  • the animals (8 week-old male C57BL/6J mice) were subjected to cuprizone diet plus rapamycin injections (CR, 10 mg/kg)) for 12 weeks to induce demyelination in white matter (CC, corpus callosum). After 12 weeks, CR was discontinued and subsets of animals were treated daily for 6 weeks with either vehicle (oral IRX4204 vehicle) or IRX4204 (10 mg/kg, PO). All animals were sacrificed after 12 weeks of CR or after further 6 weeks of treatment to evaluate myelin in white matter (corpus callosum) and gray matter (hippocampus and cortex). In addition, the size of myelinated axons was quantified and the large myelinated axons were further assessed by 3D-electron microscopy (3D-EM).
  • 3D-EM 3D-electron microscopy
  • Demyelinating diseases such as MS
  • MS are characterized by myelin loss, chronic inflammation, and axonal and oligodendrocyte loss in the CNS.
  • the etiology of MS remains unknown, the disease generally starts with sporadic, acute episodes and develops over time into a chronic and progressive state.
  • the acute and chronic demyelinated lesions of MS can be demonstrated in cuprizone-diet induced mouse models that depend for severity upon the duration of cuprizone administration.
  • Cuprizone induces extensive demyelination in adult mouse brain and simultaneous administration of rapamycin blocks the differentiation of oligodendrocytes and prevents spontaneous remyelination during the demyelination phase.
  • This model also demonstrates the hippocampal demyelination in MS.
  • CR rapamycin
  • Floating brain sections are immunostained with myelin prolipid protein (PLP) to visualize and quantify myelin in gray matter, hippocampus ( FIG. 16A ) and cortex ( FIG. 16B ).
  • PLP myelin prolipid protein
  • the percentage area covered by PLP staining in animals treated with vehicles only after discontinuation of the demyelination regimen is significantly greater than in animals who were sacrificed immediately after CR demyelination demonstrating the occurrence of spontaneous remyelination.
  • IRX4204 significantly increases the size of myelinated axons in the corpus callosum ( FIG. 17 ). In addition, these large myelinated fibers demonstrate a healthy phenotype. Thus, IRX4204 and has a neuroprotective effect on myelinated neurons.
  • IRX4204 plus thyroxine increases the number and density of myelinated axons in white and gray matter in addition to increasing the size of myelinated axons in the corpus callosum.
  • the modified cuprizone model facilitates reliable, reproducible and unequivocal analysis of neurodegeneration caused by demyelination.
  • SMI-32 immunostaining enables the visualization and quantification of swollen and transected axons (ovoids) in the corpus callosum and enables the assessment of the extent of axonal degeneration.
  • the test articles were administered concurrently with CR for 6 weeks.
  • IRX4204 was administered orally once daily at 10 mg/kg body weight. Thyroxine (T4) treatment was initiated one day after initiation of the IRX4204 treatment. T4 was administered subcutaneously (SC) once daily at 20 ng/g body weight. The CR+ vehicles group received the IRX4204 vehicle (oral) and the T4 vehicle (SC). All animals were subjected to terminal blood collection to determine plasma T4 levels. After sacrifice, the density of SMI-32 positive ovoids per unit area was determined for each group. The higher the SMI-32 positive ovoid density, the greater the extent of axonal degeneration.
  • a RXR agonist can regulate T cell differentiation.
  • the ability of an RXR agonist to promote Treg cell differentiation and inhibit Th17 cell differentiation under Th17 cell differentiation conditions was assessed by monitoring Foxp3 and IL-17A expression.
  • Naive CD4 + CD25 ⁇ FoxP3 ⁇ cells were purified from a Foxp3-GFP mouse using flow cytometry by sorting and isolating based upon a GFP ⁇ phenotype. These cells were then cultured under Th17 cell differentiation conditions in media with 0 nM, 1 nM, 10 nM, and 100 nM of RXR agonist IRX4204 (194204) and the expression of Foxp3 and IL-17A was analyzed.
  • RXR Agonists Regulate T Cell Differentiation Independent of RAR Signaling
  • T cells were incubated with a RXR agonist in the presence of a pan-RAR antagonist and the expression of Foxp3 was assessed.
  • Naive CD4 + CD25 ⁇ FoxP3 ⁇ cells were purified from a Foxp3-GFP mouse using flow cytometry by sorting and isolating based upon a GFP ⁇ phenotype. These cells were then cultured under Treg cell differentiation conditions by treating the cells with ⁇ CD3 and ⁇ CD28 polyclonal antibodies in the presence of IL-2 and TGF- ⁇ .
  • the cultured cells were incubated with RXR agonist IRX4204 (194204) at 1.0 nM together with 0 nM, 1 nM, or 10 nM of a pan-RAR antagonist 194310.
  • the cultured cells were then assayed for the expression of Foxp3.
  • the results indicate that the inclusion of a pan-RAR antagonist only partially blocked the induction of Foxp3 expression observed with an RXR agonist alone ( FIG. 22 ). However, this partial inhibition of Fox3p expression may actually be due to the blocking of the effects of endogenous RA in the culture medium. As such, these results indicate that the observed conversion of T cells into Treg cells appears to occur through the use of RXR receptor homodimers and/or some other RXR containing complex, and not through a RAR-mediated mechanism.
  • Collagen-induced arthritis is elicited in genetically susceptible strains of mice by immunization with type II collagen (CII) emulsified in complete Freund's adjuvant (CFA).
  • CFA complete Freund's adjuvant
  • mice are injected intradermally in the tail with 50 ⁇ l type II collagen emulsified in Freund's complete adjuvant at a 1:1 ratio.
  • An optional booster immunization can be used of CII emulsified in incomplete Freund's adjuvant (IFA) 14-21 days after the primary immunization. Animals exhibit signs of RA between 5 and 8 weeks after the primary immunization. Arthritis is scored according to the system in Table 4.
  • mice are randomized into groups of four groups of five mice each; Group 1—vehicle control; Group 2—IRX4204 alone; Group 3—IRX4204 and thyroxine; and Group 4—positive control.
  • the mice are dosed daily with the indicated drug and arthritis severity scored every other day.
  • the objectives of this study were to further characterize the safety and tolerability of IRX4204 in early patients, particularly reduction in T4 levels, and to evaluate the effect of treatment with IRX4204 on the motor symptoms of PD measured by the UPDRS.
  • the study endpoints were (1) the change in motor testing scores from end of dosing period (Day 17), and (2) changes in T4 levels.
  • subjects were required to meet the following criteria: 40-80 years of age, inclusive; have a clinical diagnosis of PD based on the UK Brain Bank Criteria; participant has Hoehn and Yahr stage ⁇ 3; participant may be treated with PD symptomatic therapy on a stable dose for at least 30 days prior to the Screening Visit.
  • Dose levels of PD symptomatic therapies will remain stable through the study; must be willing and able to provide informed consent; females must be of either non-child bearing potential or must be willing to avoid pregnancy by using medically accepted contraception for 4 weeks prior to and 4 weeks following the last dose of study medication.
  • Subjects who met any of the following criteria were not included in the study: has any form of Parkinsonism other than idiopathic PD; are currently experiencing motor fluctuations (end of dose wearing off or dyskinesia) reflective of later stages of PD; has evidence of dementia or significant cognitive dysfunction; has clinically significant abnormal laboratory value and/or clinically significant unstable medical or psychiatric illness; the subject has any disorder that may interfere with drug absorption, distribution, metabolism or excretion; the subject has evidence of clinically significant gastrointestinal, cardiovascular, hepatic, pulmonary, or other disorder or disease; pregnancy or breastfeeding.
  • the clinical site prepared the study drug for administration by dispensing the correct dosage (20 mg/day, 10 mg/day or 5 mg/day) of IRX4204 for each subject.
  • subjects received their first dose of IRX4204.
  • IRX4204 drug dosing occurred at home daily.
  • Patients took their daily dose of study medication with food approximately the same time each day, preferably between 8 AM and 10 AM.
  • subjects received a 15-day supply of IRX4204 for a once daily dose of 20 mg, 10 mg, or 5 mg. Five subjects were recruited for each of the three dose levels. All fifteen subjects completed 15 days of dosing.
  • the average percent changes in Total Motor and Total UPDRS scores for the three dose levels are given in Table 5.
  • a negative score indicates an improvement in the disease as measured by the comprehensive UPDRS evaluation.
  • the largest therapeutic response to IRX4204 treatment as measured by the Total Motor score ( ⁇ 31.4%) was obtained for the lowest dose of IRX4204 (5 mg/day).
  • the best therapeutic response was obtained with the 5 mg/day cohort ( ⁇ 18.7%).
  • Each of the higher doses, 10 mg/day and 20 mg/day were progressively less efficacious with total UPDRS changes of ⁇ 13.6% and 6.6%, respectively.
  • the average percent changes in plasma T4 levels for the three cohorts are given in Table 6.
  • the relationship between dose level and percentage reduction in plasma thyroxine (T4) was direct: the higher the dose of IRX4204 the greater the decrease in T4 levels.
  • the 20 mg/day dose of IRX4204 leads to an almost complete abrogation of plasma T4 (98.8% reduction).
  • this high dose of IRX4204 is associated with the least efficacy (only a 6.6% reduction in Total UPDRS scores).
  • the purpose of this study was to evaluate IRX4204 treatment for amelioration of behavioral deficits in the rat 6-OHDA induced Parkinson Disease (PD) model.
  • the rat model of PD was produced by unilateral intra striatum injection of the neurotoxin 6-hydroxydopamine (6-OHDA). This injection produces dopaminergic (DA) neuron loss on the injected side while sparing the contralateral DA neurons.
  • DA dopaminergic
  • the paw placement was used for assessment of the damage. This test assessed a rat's independent forelimb use to support the body against the walls of a cylindrical enclosure. The test took advantage of the animals' innate drive to explore a novel environment by standing on the hind limbs and leaning towards the enclosing walls.
  • the statistical analysis was performed as ratio between the intact and impaired legs (R/L ratio).
  • the ratio was expressed as the values of intact right+ both forelimbs divided by the values of impaired left+ both forelimbs.
  • a lower value of the ratio means greater healing of the 6-OHDA induced brain damage.
  • Paw placement was measured prior to induction of lesion (baseline) and again 3 days after 6-OHDA injection, which was one day prior to IRX4204 treatment. Once a week during three weeks (study days 10, 17 and 24), the animals were re-tested for their performance in the paw placement test.
  • the average value of the ratio was calculated from the four values from days 3, 10, 17 and 24.
  • the calculated values for group 2 and group 4 are 3.79 and 3.14, respectively. This indicates that group 4 (IRX4204 in combination with thyroxine and triiodothyronine) is more effective than group 2 (IRX4204) alone.
  • OPCs mouse oligodendrocyte progenitor cells
  • Therapeutic agents were tested in 96-well plates (6 wells per concentration). Negative and positive controls (DMSO or 10 ng/ml T3 thyroid hormone) were included in each plate. All media contained 0.1% DMSO and 0.1% EtOH. At the end of the 5-day treatment, cells were imaged on Cellomics in two channels and algorithms were used to count nuclei and EGFP+ oligodendrocytes.
  • OPCs mouse oligodendrocyte progenitor cells
  • Therapeutic agents were tested in 96-well plates (6 wells per concentration). Negative and positive controls (DMSO or 10 ng/ml T3 thyroid hormone) were included in each plate. All media contained 0.1% DMSO. At the end of the 5-day treatment, cells were imaged on Cellomics in two channels and algorithms were used to count nuclei and EGFP+ oligodendrocytes.
  • FIG. 15A-C show clear dose-responses in oligodendrocyte production in response to different doses of IRX4204 and T3.
  • the production of oligodendrocytes in response to combination treatments of IRX4204 and T3 was more than that of individual treatment alone in all conditions. This suggests an additive, or potentially a synergistic, effect in driving oligodendrocyte precursor cell differentiation between IRX4204 and T3. Similar results were obtained when cells were stained with MBP antibody and quantified (data not shown). These data suggest that a combination of IRX4204 and T3 (or T4) will be optimal in remyelination.
  • the goal of this study was to evaluate the neuroprotective effect of IRX4204 in a mouse model of non-immune mediated demyelination.
  • mice Females (8 week-old male C57BL/6J mice) were subjected to cuprizone diet plus rapamycin injections (CR) for 6 weeks to induce demyelination. Animals were treated with either vehicle or IRX4204 (10 mg/kg, PO), or IRX4204+T4 (10 mg/kg, PO, and 20 ng/g, SQ) daily for the entire 6 weeks during demyelination. All animals were sacrificed after 6 weeks of CR to evaluate axonal integrity and microglial/macrophage activity in the white matter (corpus callosum, CC). Two groups (Vehicle and IRX4204+T4) were further examined for any protective effects on the extent of myelination in the CC.
  • IRX4204 10 mg/kg, PO
  • IRX4204+T4 10 mg/kg, PO, and 20 ng/g, SQ
  • the floating brain sections were immunostained with SMI-32 to visualize and quantify axonal ovoids in the CC.
  • Animals that were subjected to CR showed significantly higher numbers of SM132 stained axonal ovoids in CC compared to na ⁇ ve animals.
  • IRX4204 alone showed a trend towards decreased number of axonal ovoids but was not statistically different from the Vehicle.
  • the floating brain sections were immunostained with Iba-1 to visualize and quantify microglia/macrophages in CC.
  • Animals subjected to CR and treated with Vehicle had a robust increase in Iba1 staining in CC compared to na ⁇ ve animals.
  • IRX4204 treatment alone without T4 showed a trend towards decrease in axonal ovoids, but it was statistically not different from vehicle.
  • animals that received IRX4204 were supplemented with exogenous T4 there was a significant decrease in the number of axonal ovoids compared to vehicle.
  • This data along with our previous in vivo findings support a neuroprotective effect of IRX4204. While there was a decrease in axonal ovoids, there was no significant difference in microglial/macrophage activation and myelination in the corpus callosum in Vehicle and IRX4204+T4 groups.
  • IRX4204 demonstrated a neuroprotective effect only in the group with supplemental T4 suggests an enhanced effect of the combination therapy over IRX4204 alone.
  • FIG. 20A-C shows a high correlation between the number of axonal ovoids and myelinated axons (i.e. the animals that had very few ovoids had very high number and density of myelinated axons in the corpus callosum).
  • RA rheumatoid arthritis
  • Patients with RA are recruited to participate in the clinical trial and are provided informed consent describing risks and potential benefits of participation.
  • the RA patients are treated with one of several dose levels of IRX4204, ranging from 1 mg/day to 40 mg/day, administered orally as capsules, once per day and thyroxine, administered at 12.5 ⁇ g/day to 250 ⁇ g/day orally.
  • Some patients are randomized to receive a placebo dose using matching capsules, which do not contain IRX4204 or thyroxine, or IRX4204 alone.
  • Patients are dosed for a minimum of 30 days, and as long as 2 years. The patients' serum thyroid hormone levels are tested periodically and the thyroxine dose adjusted as necessary. Patients are assessed for RA disease activity through the DAS clinical index. Dose response relationships of the IRX4204/thyroxine combination to RA diagnostic criteria and DAS scores are analyzed across the cohorts of patients treated with various dose levels of IRX4204 and thyroxine for patient reaction and any affect on RA disease activity.
  • a proof of concept clinical trial of the combination of IRX4204 and thyroxine is conducted in psoriasis patients to ascertain the direct effects of the combination in such a patient group.
  • Patients with psoriasis are recruited to participate in the clinical trial and are provided informed consent describing risks and potential benefits of participation.
  • the psoriasis patients are treated with one of several dose levels of IRX4204, ranging from 1 mg/day to 40 mg/day, administered orally as capsules, once per day and thyroxine, administered at 12.5 ⁇ g/day to 250 ⁇ g/day orally.
  • Some patients are randomized to receive a placebo dose using matching capsules, which do not contain IRX4204 or thyroxine, or to capsules containing IRX4204 alone. Patients are dosed for a minimum of 30 days, and as long as 2 years. The patients' serum thyroid hormone levels are tested periodically and the thyroxine dose adjusted as necessary. Throughout the clinical trail, patients are assessed for psoriasis activity through physical examination by a dermatologist or a like medical professional and monitoring of psoriatic episodes. Dose response relationships of the IRX4204/thyroxine combination are analyzed across the cohorts of patients treated with various dose levels of IRX4204 and thyroxine for patient reaction and any affect on psoriasis activity.
  • a proof of concept clinical trial of the combination of IRX4204 and thyroxine is conducted in patients with Crohn's disease, in patients to ascertain the direct effects of the combination in such a patient group.
  • Patients with Crohn's disease are recruited to participate in the clinical trial and are provided informed consent describing risks and potential benefits of participation.
  • the Crohn's disease patients are treated with one of several dose levels of IRX4204, ranging from 1 mg/day to 40 mg/day, administered orally as capsules, once per day and thyroxine, administered at 12.5 ⁇ g/day to 250 ⁇ g/day orally.
  • Some patients are randomized to receive a placebo dose using matching capsules, which do not contain IRX4204 or thyroxine.
  • Patients are dosed for a minimum of 30 days, and as long as 2 years. The patients' serum thyroid hormone levels are tested periodically and the thyroxine dose adjusted as necessary. Throughout the clinical trail, patients are assessed for Crohn's disease activity through laboratory tests, such as, but not limited to complete blood cell tests, electrolyte panel, liver function tests, and fecal occult blood tests. Dose response relationships of the IRX4204/thyroxine combination are analyzed across the cohorts of patients treated with various dose levels of IRX4204 and thyroxine for patient reaction and any affect on Crohn's disease activity.

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